Murat KUS, Ufuk UYLAS, Ramazan GÜNDOĞDU, Serkan ERKAN, Kenan CALİSKAN

Is lobectomy an effective treatment method in giant hepatocellular carcinomas?

Aim: Hepatocellular carcinomas (HCC) are diagnosed at a high frequency worldwide. The most effective treatment method is surgery. Surgical treatment of giant HCCs (HCCs ≥10 cm in diameter) remains controversial due to its advanced stage. In this study, we discuss the surgical treatment of patients with HCC with a tumor size ≥10 cm, as well as early complications and effect on survival. Materials and Methods: Patients who underwent surgical treatment for HCC in our clinic between 2011 and 2021 were retrospectively reviewed. Patients older than ≥18 years of age who were treated with anatomical lobectomy and whose files were not missing any data were included in the study. Demographic characteristics, surgery and pathology reports, and survival data of the patients were analyzed. Results: A total of seven patients, five of whom were men, were included in the study, and the median age was 66 years (range 28–76). The median tumor diameter was 20 cm (range 10.5–24). Anatomical lobectomy was performed in all patients. The median duration of hospitalization was 4 days (range 3–7). Perioperative morbidity and mortality were not observed. At least one liver recurrence was observed in all patients during follow-up. Pulmonary metastasis was detected in two patients during follow-up. The median survival was 24 months (range 7–60). Conclusion: We think that lobectomy can be applied with low perioperative morbidity and mortality in patients with selected giant HCCs in experienced centers such as our clinic.

PDF

___

1. Budny A, Kozłowski P, Kamińska M, et. al. Epidemiologia i czynniki ryzyka rozwoju raka wątrobowokomórkowego [Epidemiology and risk factors of hepatocellular carcinoma]. Pol Merkur Lekarski 2017;43:133-9.
2. Cescon M, Vetrone G, Grazi GL, et. al. Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg 2009;249:995-1002.
3. Dimitroulis D, Damaskos C, Valsami S, et. al. From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world. World J Gastroenterol 2017;23:5282-94.
4. Zhang X, Li J, Shen F, Lau WY. Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma. J Gastroenterol Hepatol 2018;33:347-54.
5. Thng Y, Tan JK, Shridhar IG, et. al. Outcomes of resection of giant hepatocellular carcinoma in a tertiary institution: does size matter? HPB (Oxford) 2015;17:988-93.
6. Yamashita Y, Taketomi A, Shirabe K, et. al. Outcomes of hepatic resection for huge hepatocellular carcinoma (>10 cm in diameter). J Surg Oncol 2011;104:292-8.
7. Liau KH, Ruo L, Shia J, et. al. Outcome of partial hepatectomy for large (> 10 cm) hepatocellular carcinoma. Cancer 2005;104:1948-55.
8. Zhu SL, Chen J, Li H, et. al. Efficacy of hepatic resection for huge (≥ 10 cm) hepatocellular carcinoma: good prognosis associated with the uninodular subtype. Int J Clin Exp Med 2015;8:20581-8.
9. Centers for Disease Control and Prevention (CDC). Hepatocellular carcinoma - United States, 2001-2006. MMWR Morb Mortal Wkly Rep 2010;59:517-20.
10. Theilig D, Elkilany A, Schmelzle M, et. al. Consistency of hepatocellular gadoxetic acid uptake in serial MRI examinations for evaluation of liver function. Abdom Radiol (NY) 2019.
11. Budny A, Kozłowski P, Kamińska M, et. al. Epidemiologia i czynniki ryzyka rozwoju raka wątrobowokomórkowego [Epidemiology and risk factors of hepatocellular carcinoma]. Pol Merkur Lekarski 2017;43:133-9.
12. Perz JF, Armstrong GL, Farrington LA, et.al.The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-38.
13. Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 2010;30:61-74.
14. Chen YS, Hsieh PM, Lin HY et al. Surgical resection significantly promotes the overall survival of patients with hepatocellular carcinoma: a propensity score matching analysis. BMC Gastroenterol 2021;21:220.
15. Kadohisa M, Sugawara Y, Shimata K, et. al. Duodenal ulcer as a postoperative complication in the donor in living-donor liver transplantation. Transplant Proc 2018;50:1129-31.
16. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 2003;7:325-30.
17. Viganò L, Ferrero A, Sgotto E, et. al. Bile leak after hepatectomy: predictive factors of spontaneous healing. Am J Surg 2008;196:195-200.
18. Birgin E, Tesfazgi W, Knoth M, et. al. Evaluation of the New ISGLS definitions of typical posthepatectomy complications. Scand J Surg 2019;108:130-6.
19. Torzilli G, Gambetti A, Del Fabbro D, et. al. Techniques for hepatectomies without blood transfusion, focusing on interpretation of postoperative anemia. Arch Surg 2004;139:1061-5.
20. Skrzypczyk C, Truant S, Duhamel A, et. al. Relevance of the ISGLS definition of posthepatectomy liver failure in early prediction of poor outcome after liver resection: study on 680 hepatectomies. Ann Surg 2014;260:865-70.
21. Hartke J, Johnson M, Ghabril M. The diagnosis and treatment of epatocellular carcinoma. Semin Diagn Pathol 2017;34:153-9.
22. Lee SG, Hwang S, Jung JP, et. al. Outcome of patients with huge hepatocellular carcinoma after primary resection and treatment of recurrent lesions. Br J Surg 2007;94:320-6.